Recent clinical and anthropological findings indicate that the conventional concept of the pathogenesis of periodontal disease requires review. The periodontal lesion has been defined as a generalised horizontal loss of crestal bone resulting from host immune and inflammatory responses triggered by the action of commensal bacteria, and the extension of gingivitis into the deeper periodontium to become periodontitis has been assumed to occur slowly but steadily over many years. Anthropological and clinical investigations reveal that the widespread loss of crestal tissue is relatively unusual and that lesions of the alveolus are commonly localised and severe. Longitudinal studies have shown that the disease progresses in bursts and is stable in both the gingivitis and periodontal modes in between the burst activity. The findings of the present study demonstrate that generalized horizontal periodontitis has been unusual and has not been responsible for tooth loss. Other factors responsible for deficient alveolar margins in dry bones have been overlooked in most studies, leading to overassessment of the incidence of periodontal disease in postmortem materials; the same assumptions have led to overassessment of periodontal disease in clinical studies and practice.
The pattern of dental service utilization, the perception of periodontal disease, and the oral hygiene habits among 642 industrial employees were evaluated using a self-administered questionnaire against background variables of age, sex, and socioeconomic strata. Of the study population, 50.5% had their most recent dental visit within the previous 12 months and 42.5% claimed to seek regular check ups. There was no significant association between time intervals since the last dental visit and age, sex, occupation, income or education. Regular visits were made more often by subjects in the higher occupation and income level. Multivariate analyses of the number of missing teeth simultaneously considering age, sex, socioeconomic level, regularity and frequency of dental visits revealed that except for age and sex, no other factors were significant. The most common reason for not seeing a dentist in the previous 12 months was an assumption that "nothing was wrong". A large majority of the group surveyed were unaware of the presence of periodontal disease or the need for its treatment, despite the high prevalence in all subgroups. Periodontal status was not significantly associated with sex, socioeconomic levels, regularity of frequency of dental visits, but there was a significant regression on age. The study population's pattern of service utilization was found to be similar to that reported for the general population, and it was anticipated that the hygiene habits of the group was representative of the total community. If that assumption is true the high prevalence of periodontal disease of the study population probably exists in the general community.
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